Avaliação do perfil lipídico, sdLDL e da apolipoproteína A-I: relação com enzimas associadas ao rico cardiovascular em pacientes com hipogamaglobulinemia
Data
2013
Autores
Vieira, Daniele Gonçalves 
Orientadores
Sarni,Roseli Oselka Saccardo
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A ImunodefiCiência Comum Variavel (ICV) e a Agamaglobulinemia Ligada ao X (XLA) sao imunodefiCiências primarias (IDP´s) classificadas como defiCiências de anticorpos resultando em hipogamaglobulinemia. Em semelhanca com outras doencas cronicas, as IDPÆs podem cursar com disturbios inflamatorios, endocrinos e com a exacerbacao do estresse oxidativo. Com a melhoria nos protocolos de atendimento clinico houve impacto positivo na sobrevida destes pacientes, surgindo assim preocupacao com o risco para o desenvolvimento de outras doencas cronicas, como as cardiovasculares. Objetivos: Avaliar o perfil lipidico e a concentracao serica da apolipoproteina A-I (apo A-I) e da particula pequena e densa do LDL-c (sdLDL), e relaciona-las com biomarcadores associados ao risco de doenca cardiovascular dos pacientes com ICV e XLA. Casuistica e Metodos: Foram avaliados, por meio de estudo transversal e controlado, 24 pacientes atendidos no Departamento de Pediatria da UNIFESP e 12 controles saudaveis pareados por idade e sexo com os pacientes. Foram realizadas a avaliacao antropometrica e dosagens sericas de colesterol total (CT) e as fracoes HDL-c e LDL-c, com analise da apo A-I e quantificacao de sdLDL, triglicerideos (TG), proteina C reativa (CRP), fator de necrose tumoral alfa (TNF-alfa) e as enzimas relacionadas ao risco cardiovascular mieloperoxidase (MPO), proteina de transferencia de ester de colesterol (CETP) e a lecitina colesterol aciltransferase (LCAT). Resultados: As concentracoes da CRP (p=0,008) e TNF-alfa (p<0,001) foram significativamente mais elevadas, enquanto o HDL-c (p=0,025) e a apo A-1 (p=0,013) foram significantemente mais baixas nos pacientes comparativamente aos controles. No grupo de pacientes foi observada correlacao negativa e significante entre o HDL-c e o TNF-alfa (r=-0,406; p=0,049) e os TG (r=-0,641; p=0,001). Verificou-se diferenca estatisticamente significante para a idade (p= 0,024), indice de massa corporal (p=<0,001), circunferencia abdominal (p=0,001), TG (p=0,020), MPO (p=0,036) e TNF-alfa (p=0,045) quando se comparou entre os pacientes a presenca ou nao de dislipidemia para HDL-c. Conclusao: Os pacientes com IDPÆs demonstraram risco cardiovascular elevado caracterizado pela elevacao de marcadores inflamatorios em associacao com enzimas que participam da oxidacao de lipoproteinas. A identificacao precoce dessas alteracoes permite o estabelecimento de medidas de prevencao e tratamento visando a reducao do risco cardiovascular nesses pacientes
Abstract Introduction: Common Variable Immunodeficiency (CVID) and Xlinked agammaglobulinemia (XLA) are primary immunodeficiencies (IDP 's) classified as antibody deficiencies resulting in hypogammaglobulinemia . In a similar fashion as other chronic diseases, IDPs may be associated with inflammatory and endocrine disorders, and the exacerbation of oxidative stress. The improvement in treatment protocols had a positive impact on patient survival raising the concern of the development of other chronic diseases such as cardiovascular disease. Objectives: Evaluate the lipid profile and serum concentration of apolipoprotein AI (apo AI) , and particle small dense LDLc (sdLDL) relating them to biomarkers associated with of cardiovascular risk disease in patients with CVID and XLA. Methods: We evaluated, through controlled crosssectional study, 24 patients treated at the Department of Pediatrics UNIFESP. Anthropometric measurements were performed, food consumption, serum total cholesterol (TC) and HDLc and LDLc, apo AI with the analysis and quantification of sdLDL, triglycerides (TG), Creactive protein (CRP), tumor necrosis factor alpha (TNFalpha) and the enzymes related to cardiovascular risk myeloperoxidase (MPO), cholesteryl ester transfer protein (CETP) and lecithin cholesterol acyltransferase (LCAT). Results: The concentrations of CRP (p=0.008) and tumor necrosis factoralpha (p< 0.001) were significantly higher, while HDLC levels (p=0.025) and apo AI (p=0.013) were significantly lower in patients compared to controls. The patients group had a significant negative correlation between HDLc and TNFalpha (r=0.406, p=0.049) and TG (r =0.64, p=0.001). There was a statistically significant difference for age (p = 0.024), BMI (p=< 0.001), CA (p=0.001), TG (p=0.020), MPO (p=0.036) and TNFalpha (p=0.045) in patients with dyslipidemia in the presence or absence of HDLc. Conclusion: Patients with IDPs showed elevated cardiovascular risk characterized by elevated inflammatory markers in association with enzymes that participate in lipoprotein oxidation. The early identification of these changes can allow the establishment of prevention and treatment in order to reduce risk in these patients.
Abstract Introduction: Common Variable Immunodeficiency (CVID) and Xlinked agammaglobulinemia (XLA) are primary immunodeficiencies (IDP 's) classified as antibody deficiencies resulting in hypogammaglobulinemia . In a similar fashion as other chronic diseases, IDPs may be associated with inflammatory and endocrine disorders, and the exacerbation of oxidative stress. The improvement in treatment protocols had a positive impact on patient survival raising the concern of the development of other chronic diseases such as cardiovascular disease. Objectives: Evaluate the lipid profile and serum concentration of apolipoprotein AI (apo AI) , and particle small dense LDLc (sdLDL) relating them to biomarkers associated with of cardiovascular risk disease in patients with CVID and XLA. Methods: We evaluated, through controlled crosssectional study, 24 patients treated at the Department of Pediatrics UNIFESP. Anthropometric measurements were performed, food consumption, serum total cholesterol (TC) and HDLc and LDLc, apo AI with the analysis and quantification of sdLDL, triglycerides (TG), Creactive protein (CRP), tumor necrosis factor alpha (TNFalpha) and the enzymes related to cardiovascular risk myeloperoxidase (MPO), cholesteryl ester transfer protein (CETP) and lecithin cholesterol acyltransferase (LCAT). Results: The concentrations of CRP (p=0.008) and tumor necrosis factoralpha (p< 0.001) were significantly higher, while HDLC levels (p=0.025) and apo AI (p=0.013) were significantly lower in patients compared to controls. The patients group had a significant negative correlation between HDLc and TNFalpha (r=0.406, p=0.049) and TG (r =0.64, p=0.001). There was a statistically significant difference for age (p = 0.024), BMI (p=< 0.001), CA (p=0.001), TG (p=0.020), MPO (p=0.036) and TNFalpha (p=0.045) in patients with dyslipidemia in the presence or absence of HDLc. Conclusion: Patients with IDPs showed elevated cardiovascular risk characterized by elevated inflammatory markers in association with enzymes that participate in lipoprotein oxidation. The early identification of these changes can allow the establishment of prevention and treatment in order to reduce risk in these patients.
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Citação
VIEIRA, Daniele Gonçalves. Avaliação do perfil lipídico, sdLDL e da apolipoproteína A-I: Relação com enzimas associadas ao rico cardiovascular em pacientes com hipogamaglobulinemia. 2013. 73 f. Dissertação (Mestrado em Pediatria) - Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2013.